Journal of Ayub Medical College Abbottabad

ADMISSION WITH ACUTE ABDOMEN: PRESENTATION, CONDITIONS IDENTIFIED AND MANAGEMENT OUTCOMES

Wed, 17 Apr 2024 00:00:00 +0000

Background: Acute abdomen is one of the few conditions that require immediate surgical intervention most of the time. However, not all cases of acute abdomen need surgery. The objective was to determine the various presentations of acute abdomen and their management outcome in patients presenting with acute abdomen to AIMS, Muzaffarabad, Azad Jammu and Kashmir, Pakistan. Methods: This prospective cohort study included individuals aged 18 and above who presented with abdominal pain lasting at least eight hours. Patients with trauma-induced abdominal pain were excluded. Consecutive non-probability sampling facilitated participant recruitment. Results: The majority (54%) were young, and males outnumbered females (62.61% and 37.39% respectively. Most patients presented within 8 hours of pain onset, diabetes and hypertension were the commonest comorbid. Mild pain was most common at presentation. In descending order, acute Appendicitis, acute cholecystitis, acute pancreatitis, intestinal obstruction, Peritonitis, UTIs, and gynaecological & obstetric conditions were the frequent reasons for abdominal pain. Conclusion: Recognizing the patterns of conditions that present as acute abdomen is essential for healthcare planners to develop effective treatment protocols, as incorrect management can lead to significant consequences.

COMPARISON OF POSTOPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT WITH AND WITHOUT LONG CPB TIME

Mon, 22 Apr 2024 00:00:00 +0000

Background: Postoperative atrial fibrillation (POAF) is frequently observed after cardiac surgery, and duration of Bypass Time (CPB) is an independent risk factor for postoperative atrial fibrillation (POAF). The main objective of the current study was to compare new onset Postoperative Atrial Fibrillation (POAF) in patients undergoing coronary artery bypass graft with and without long CPB time. Methods: A prospective comparative study design was used and conducted at the Cardiac Surgery Department in Bahawalpur- Pakistan which is a tertiary care health centre for the period of April 2020 to February 2021, a total of 110 patients were enrolled after getting institutional approval and informed consent from patients. The ethical protocol was followed throughout the study period. Data was entered and analyzed using SPSS version 25.0 and p-value <0.05 taking the level of significant. Results: A total of 110 patients were enrolled for the research, the average age of patients was 48.56±3.11 (age range 30–70), and there were 38(34.55%) & 72(65.45%) male and female patients observed respectively. The atrial fibrillation developed in 3(5.45) patients in without a long CPB time group as compared with the long CPB time group as 8(14.54%) with a statistically significant p-value of 0.043, postoperative IABP support with insignificant p-value of 0.234. Conclusion: Postoperative atrial fibrillation in patients undergoing coronary artery bypass graft is significantly higher with long CPB time as compared with without long CPB time

CORRELATION BETWEEN FACIOLINGUAL INCLINATION OF MAXILLARY CENTRAL INCISORS AND MOLARS WITH MAXILLARY AND MANDIBULAR MORPHOLOGY

Abdul Muqeet Chughtai, Waqar Jeelani, Maheen Ahmed, Muhammad Aman — Sun, 31 Mar 2024 00:00:00 +0000

Background: The torque of maxillary incisors and molars forms an important component of smile esthetics. The inclination of these teeth may be affected by maxillary and mandibular dimensions. The study aimed to evaluate the correlation between the faciolingual inclinations of maxillary incisors and first molars with palatal width (PW), palatal depth (PD), maxillomandibular angle (MMA) and mandibular width (MW) using cone beam computed tomography scans. Methods: A retrospective analysis of cone-beam computed tomography (CBCT) images of 66 adult subjects (males-37; females-29) was performed. The Planmeca Romexis viewer 6.2.1 software was utilized to determine the faciolingual inclination of the maxillary central incisor (UIPP) and first molars (right-MMR; left-MML). The correlation of UIPP, MMR and MML with age, PW, PD, MW and MMA was determined using Pearson’s correlation. Results: The mean age of the sample was 32.8±11.4 years. The UIPP showed a mild negative correlation with age (r=-0.430; p<0.001). Only the PW showed a mild significant correlation with MMR (r=-0.287; p=0.019) and MML (r=-0.343; p=0.005). All the other maxillomandibular parameters had insignificant (p>0.05) correlations with the inclinations of maxillary incisors and molars. Conclusion: The current study concludes that the PW had a significant inverse correlation with bilateral maxillary molar inclinations. Other parameters such as MMA, MW and PD had no statistically significant correlation with incisors and molars inclinations.

IMPROVING VTE RISK ASSESSMENT IN HOSPITALISED PATIENTS IN A TERTIARY CARE HOSPITAL IN IRELAND

Wed, 20 Mar 2024 00:00:00 +0000

Background: The initial baseline audit showed that only 24% of patients had a documented VTE- RA, this demonstrated an urgent need to improve VTE-RA in hospitalised patients. This quality improvement project (QIP) aimed to achieve 90% compliance in completing the VTE-RA tool and embedding this process into practice. Several measures were carried out which included the development of a TP policy, VTE-RA tool, education sessions and monthly point prevalence audits incorporating Plan, Do, Study, Act (PDSA) cycles. A follow-up audit was conducted one-year post-implementation using the same methodology as the baseline. Methods: This was a single centre before-after study, using a prospective cross-sectional design for both the baseline and post-intervention studies in a tertiary referral hospital in Cork, Ireland. All adult inpatients (>18 years) were eligible for inclusion. Documented evidence of VTE-RA and a prescription of TP were recorded. Results: The follow-up audit showed significant (p <0.001) improvement in documentation of VTE-RA from 24% (244/1019) to 57% (612/1070) and the prescription of pharmacological TP increased significantly (p<0.001) from 43% (441/1019) to 67% (713/1070). This improvement in VTE-RA was highest in patients with an increased risk of thrombosis from 21.9% (n=180/819) to 61% (n=493/807). Conclusion: The introduction of a TP policy and VTE-RA tool increased compliance by 33%. However, without a dedicated multidisciplinary “thrombosis team” to actively implement this, the achievements to date are unsustainable and attaining 90% compliance with VTE-RA is unlikely.

RELATIONSHIP OF MATERNAL MORBIDITY AND MORTALITY TO HIGH BODY MASS INDEX (BMI) PREGNANCIES IN PAKISTAN

Asra, Riffat Jalil, Shehla Arif — Thu, 14 Mar 2024 00:00:00 +0000

Background: The average BMI is shifting upwards even in low-resource countries like Pakistan causing an increase in pregnancy-related complications. This study was planned to elaborate the association of maternal morbidity and mortality during pregnancy and puerperium with high BMI. Methods: A descriptive longitudinal study was performed in the Obstetrics and Gynaecology Unit 2 of D. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan from 1^st August 2022 to 31^st January 2023. Women delivering in Obstetric Unit 2 having a 1st-trimester record of weight were included. Demographic data, antenatal, intrapartum and postpartum complications noted. Participants were further stratified into 2 groups based on BMI i.e. overweight (25.0-29.9) and obese (30.0 or more) and demographics and clinical characteristics compared. Univariate and multivariate logistic regression analysis was done. Data was entered and analyzed on SPSS version 21. Result: The frequency is calculated to be 15.7%. The observed complications included pre-eclampsia 16.7%, PIH 13%, eclampsia 7%, GDM 18.9%, induction of labour 19.5%, PPH in 15.2% and infected caesarean wound in 19.2% of participants. The caesarean section was the predominant mode of delivery in 55.7%. A significant relationship was found with advancing maternal age, DM/ GDM, hypertension, Pre-eclampsia, IOL, caesarean section, PPH and wound infection. The univariate and multivariate logistic regression models also showed two times higher odd in obese groups as compared to overweight groups. Conclusion: Our study underscores a strong association between maternal obesity in early pregnancy and several threatening complications during pregnancy, delivery, and the postpartum period.

EXPLORING THE PERCEPTIONS OF UNDERGRADUATE MEDICAL STUDENTS AND FACULTY REGARDING THEIR ENGAGEMENT IN INTEGRATED CURRICULUM DEVELOPMENT IN AZAD JAMMU & KASHMIR MEDICAL COLLEGE MUZAFFARABAD.

Sun, 31 Mar 2024 00:00:00 +0000

Background: The development of a medical curriculum is a multi-layered and complicated process, demanding teamwork among diverse stakeholders, including undergraduate medical students and faculty members. This study investigates the underexplored realm of stakeholder perceptions, specifically those of undergraduate medical students and faculty, regarding their engagement in the intricate process of medical curriculum development

CHRONIC INFLAMMATORY SCORE IN PATIENTS WITH DACRYOCYSTORHINOSTOMY AND CORRELATION WITH SURGICAL OUTCOME

Erum Shahid, Ruqaiya Shahid, Uzma Fasih, Asad Raza Jafri — Sun, 31 Mar 2024 00:00:00 +0000

Background: Dacryocystorhinostomy (DCR) is an ophthalmic surgical procedure for relieving obstruction from chronically inflamed nasolacrimal duct (chronic dacryocystitis). This study was performed to observe the surgical outcome of DCR in patients with chronic dacryocystitis; to grade the inflammation in lacrimal sac biopsies, using the chronic inflammatory score (CIS); and to correlate the CIS with the surgical outcome. Methods: Twenty-five patients with chronic dacryocystitis underwent DCR with lacrimal sac biopsies. The biopsies were examined microscopically, and a CIS score was assigned and graded into mild, moderate and severe. The patients were followed up. The success of DCR was evaluated at 6 months post-surgery, by syringing of the lacrimal tract. Results: The mean age of the patients was 37.76 years±12.32 SD. The mean duration of watering of the eye was 2.9 years±3.18 years. The right eye was involved in 60% and 80% of the patients were females. Severe inflammation was reported in 72%, moderate angiogenesis in 76% and moderate fibrosis in 72%, squamous metaplasia in 40%, and a reduced number of goblet cells in 72% of the biopsies. CIS was severe in 72% of the patients. At 6 months follow-up, 96% of the patients had a successful DCR. Conclusion: Although the chronic inflammatory score was severe, the DCR was successful in most of the patients, suggesting that the success of the surgical procedure is not related to the degree of inflammation. Large-scale studies are recommended for confirmation of our findings

COMPARING STRESS LEVELS AMONG MEDICAL EMERGENCY UNIT WORKERS IN TEACHING HOSPITALS ACROSS LAHORE: A QUANTITATIVE ANALYSIS OF PRECISION

Sun, 31 Mar 2024 00:00:00 +0000

Background: Stress is characterized as a condition of anxiety or tension spurred on by challenging circumstances. Stress is a normal human reaction that motivates us to deal with obstacles and dangers in our lives. The study aimed to investigate the levels of stress that employees in the medical emergency unit (MEU) industry face and any possible relationship between work satisfaction, and perceived stress. The objective of the study was to assess and compare the stress levels of MEU workers in different teaching hospitals in Lahore using the PSS-10 stress scale. Our research aims to examine and compare the perceived stress based on gender, profession, and marital status. Methods: The study employed a quantitative cross-sectional design to assess and compare stress levels among MEU workers in teaching hospitals across Lahore. The target population consisted of MEU workers in teaching hospitals across Lahore. The perceived stress levels were measured using the PSS-10 (Perceived Stress Scale) questionnaire, a widely accepted, validated, and reliable instrument for assessing stress perception in individuals. The data was subjected to both descriptive and inferential statistical analyses using the SPSS. Descriptive statistics, including means and standard deviations, were employed to summarize stress levels among medical emergency unit workers in different teaching hospitals. Independent t-tests and ANOVA were utilized to compare stress levels across teaching hospitals. Results: In this study involving 304 medical professionals, participants, on average, were 29.95 years old with a mean stress score of 20.99. The majority were female (62.8%), married (50.7%), and affiliated with Mayo Hospital (17.4%). Occupation-wise, 66.45% were doctors, and no significant difference in perceived stress was observed among professional categories. However, there was a significant difference in stress scores among hospitals, with FMH participants exhibiting lower stress compared to others (p<0.005). Conclusion: The study found significant differences in stress among medical emergency unit staff in teaching hospitals in Lahore. The results highlight the significance of targeted interventions and support initiatives to improve worker resilience and well-being in high-stress healthcare settings. It provides valuable information for improving stress management and preventive tactics.

HAEMATOLOGICAL TOXICITIES OF GEMCITABINE PLUS CISPLATIN VERSUS FLUOROURACIL, CISPLATIN, PLUS DOCETAXEL FOLLOWED BY CONCURRENT CHEMORADIOTHERAPY IN LOCOREGIONALLY ADVANCED NASOPHARYNGEAL CARCINOMA

Sat, 30 Mar 2024 00:00:00 +0000

Background: Nasopharyngeal carcinoma is endowed with unique epidemiological characteristics, treatment modalities, and prognostic considerations. Patients with bulky primary tumours and extensive nodal involvement are categorized as locoregionally advanced NPC. These patients present a high-risk cohort in terms of the unfavourable prognostic features. In this patient cohort, the 5-year local control rates have been observed to fluctuate within the range of 69–79%. The objective was the assessment of the local control and adverse haematological toxicity profiles of neoadjuvant chemotherapy (NACT) (i.e., docetaxel, cisplatin, plus fluorouracil (TCF) and gemcitabine plus cisplatin (GC)) followed by concurrent chemoradiotherapy (CCRT) in patients with locoregionally advanced nasopharyngeal carcinoma (LANPC) was the primary objective of this work. Methods: Patients aged 16–65 years, confirmed NPC, stage III-IVA disease and ECOG performance score ≤2 were enrolled in this prospective study. Besides the common CCRT regimen, the patients received NACT with docetaxel 30 mg/m², cisplatin 40 mg/m² plus fluorouracil 750 mg/m² (Group I) or gemcitabine 1 g/m² plus cisplatin 80 mg/m² (Group II). At 6 weeks after completion of CCRT, treatment response was assessed with the RECIST criteria. Adverse haematological events were evaluated with peripheral white blood cells, neutrophils, haemoglobin, and platelets after each cycle of NACT. Results: Of the total 68 enrolled patients with locoregionally advanced NPC (LANPC), 50 (73.5%) were male patients. Group I consisted of 36, while Group II comprised 32 patients. The mean (interquartile range) age of the patients in Group I was 40.9±11.6 (30.3–51.8) years, while in Group II was 38.6±11.3 (29.5–51.0) years. Complete response (CR) of the treatment was higher and partial response (PR) was lower in Group II compared to Group I (71.9% vs. 44.4% and 18.6% vs. 50%, respectively). Haematological toxicity profiles were consistent in Groups I and II, illustrating mild anaemia and lymphopenia, severe neutropenia and a mixed pattern of thrombocytopenia. Conclusion: Among patients with LANPC, GC-based NACT showed superior CR compared with TCF-based NACT. However, the haematological toxicity profiles in the two groups were comparable.

COMPARISON OF FAILURE RATE OF TEMPORARY ANCHORAGE DEVICES PLACED WITH PLATELET RICH PLASMA AND PLACEBO OVER SIX MONTHS: A SPLIT MOUTH RANDOMIZED CLINICAL TRIAL

Nofil Ahmad, Owais Khalid Durrani, Faiza Ijaz, Zuhaa Mushtaq, Iram Abbas — Sun, 31 Mar 2024 00:00:00 +0000

Background: The aim of this in vitro research was to compare and evaluate the stability of TADs coated with PRP over 6 months. TAD stability is essential for the long-term success of orthodontic treatment. PRP has become a valuable adjunct to promote healing in many procedures of oral surgery. The use of PRP in combination with bone grafts in dental treatments yields positive results in terms of improving the handling properties of the grafts and enhancing the quantity and quality of the newly formed bone. Methods: This study was conducted at Islamic International Dental College, Orthodontic Department for 6 months from April 2018 to February 2019. It was a triple-blinded study using split-mouth randomized clinical trial. Comparison of Failure of Temporary Anchorage Devices inserted with Platelet Rich Plasma and Platelet Poor Plasma (placebo) was done on 25 patients with TADs placed on the right and left sides (total of 50 TADs). Patients who had visited for comprehensive orthodontic treatment were screened according to inclusion and exclusion criteria to be included in the study. The consent form was designed in which the procedure and the reason for the study were explained to every patient selected. Each patient was given the consent form which was signed by the patient. Injection of a few drops of PRP into the pilot hole by an 18 gauge needle syringe and similarly PPP (Placebo) onto the opposing site was done. The operator was blinded during the procedure. Patients were advised to report if there was any failure of TAD.TADs were assessed on every orthodontic visit (monthly) for 6 months. Results: The total number of patients was 25, each with TAD on both the right and left sides. In a total of 50 TADs, 5 (10%) failed, 4 (8% of the total) of the left side and 1 (2% of the total) of the right side Out of these 25, 14 (56%) were males and 11 (44%) were females. In 25 patients only 1 (4%) patient showed both left and right side failure while 4 (16%) patients showed only left side failure. In terms of PPP (placebo) and PRP, the rate of failure were 3 (12%) of PPP and 2 (8%) for PRP. The mean days of failure were 46.00±3.22 and 6.50±9.192 for PPP and PRP respectively. Conclusion: From this study, it was noticed that there was no significant difference in the stability of TADs injected with PRP or PPP (placebo). Other factors such as gender, and patient or operator handedness were also not significant.

CHARACTERIZATION OF CYSTIC PANCREATIC LESIONS ON EUS, A SINGLE CENTRE EXPERIENCE

Mon, 15 Apr 2024 00:00:00 +0000

Background: Pancreatic cystic lesions are increasingly diagnosed these days due to better imaging techniques. It is important to detect the lesions and perform a detailed analysis as some of them are potentially malignant. Methods: From April 2023 to September 2023, all patients with recurrent and/ or persistent abdominal pain lasting for more than a week were assessed in the gastroenterology department of Pak-Emirates military hospital, Rawalpindi. Detailed history and examination was done. Relevant laboratory tests and an ultrasound abdomen were also carried out. Those with pancreatic lesions on ultrasound abdomen underwent EUS (endoscopic ultrasound). Amongst those undergoing EUS, 88 patients were found to have cystic pancreatic lesions. These 88 patients underwent detailed assessment with EUS-FNA (endoscopic ultrasound – fine needle aspiration) so that these pancreatic cysts could be characterized. Only some of the patients undergoing EUS-FNA had one or more of the worrisome features (solid component within the cyst, main pancreatic duct & gt; 5 mm in size, symptoms related to the cyst, family history of pancreatic cancer), and later underwent surgical resection. EUS was done with the patient in the left lateral decubitus position under intravenous sedation with midazolam. During the procedure, the patient was monitored using the cardiac monitor. Images of the pancreas, gallbladder and bile tree were obtained with the echoendoscope in the stomach and duodenum. Informed consent for the study and the endoscopic procedure was obtained from all patients. The study protocol was approved by the hospital ethics committee. Results: The study population included 50 females and 38 males. Many of these patients had one or more episodes of pancreatitis in the recent past. Most cystic lesions were found in the pancreatic body. The largest number of lesions were due to pancreatic pseudocysts. EUS was performed successfully in all patients. Findings have been summarised in the table according to gender. Conclusion: Identifying pancreatic cystic neoplasms is important since some have malignant potential. In that regard, EUS-FNA is a useful diagnostic modality and it can influence the management plan.

CHRONIC DIARRHOEA: NOT A RARE PRESENTATION OF VITAMIN B 12 DEFICIENCY

Mon, 15 Apr 2024 00:00:00 +0000

Background: Diarrhoea is defined as stool frequency of more than three times in twenty-four hours or a stool weight of more than two hundred grams and it is labelled as chronic diarrhoea if it persists for more than four weeks. Chronic diarrhoea is a common gastrointestinal problem worldwide that affects three to fifteen percent of population. Objective was to determine the efficacy of vitamin B 12 replacement in treatment of chronic diarrhoea in vitamin B deficient patients. It was a Quasi-experimental study carried out at Pakistan Ordinance Factory (POF) Hospital Wah Cantt, from September 2023 to February 2024. Methods: All the new patients of chronic diarrhoea of ages between 12–65 years who had low serum vitamin B 12 and normal serum folate levels were included in the study. The patients were booked from Medicine and Allied outpatient and they were given parenteral vitamin B12. The sub-set of patients in whom diarrhoea was settled was followed up till six months. The efficacy was defined as settlement of diarrhoea with parenteral vitamin B12 within one week. The secondary outcomes were adequacy of serum vitamin B12 levels at 2 weeks, three months and six months after treatment. All patients (100%) had adequate B12 levels till follow up. Data was analyzed through SPSS. Results: Efficacy of parenteral B12 supplementation was seen in 16 (76.2%) patients. Out of sixteen patients who responded to vitamin B12 supplementation, 10 (47.6%) patients showed improvement in less than two days, 5 (23.8%) showed improvement in less than four days and 1 (4.8) patient stopped experiencing diarrhoea within seven days of intramuscular vitamin B12 with p-value of <0.001. Conclusion: Replacement of vitamin B 12 in patients with chronic diarrhoea having low vitamin B 12 results in settlement of diarrhoea.

ANTIBIOTIC SENSITIVITY SPECTRUM OF ACUTE BACTERIAL CHOLANGITIS: TRENDS FROM A TERTIARY REFERRAL CENTER IN PAKISTAN

Sun, 31 Mar 2024 00:00:00 +0000

Background: Significant morbidity can arise from acute bacterial cholangitis. Key to improving outcomes is the implementation of aggressive antibiotic therapy and prompt biliary decompression through either endoscopic or percutaneous means. However, the challenge in treating these infections is amplified by the evolving patterns of antimicrobial resistance, particularly when determining the appropriate empiric therapy. Methods: The present study was conducted at Shifa International Hospital in Islamabad. The patients with the diagnosis of Acute bacterial cholangitis between July 2016 and June 2022 were included. Data was analyzed using SPSS-26.0 to identify any significant associations or correlations among the study variables. Results: A total of 144 patients with a diagnosis of acute bacterial cholangitis were included in the study. 51 of these patients had a positive blood culture. The most commonly identified organism was E. coli, followed by Klebsiella pneumonia, Pseudomonas aeruginosa, Proteus, Enterococcus spp and others. Antibiotic sensitivity pattern revealed resistance to Ceftazidime in 87%, Piperacillin-Tazobactam in 63.7%, Ertapenem in 34.4%, Meropenem in 26.1%, Imipenem in 25.0% and Colistin in 16.1%. Conclusion: A high resistance pattern for antibiotics was observed in our study. This might, in turn, represent the prior judicious use of antibiotics in our community hospitals before these patients are referred to a tertiary referral center.

EFFECT OF COMPREHENSIVE DENTAL TREATMENT UNDER GENERAL ANAESTHESIA ON CHILDREN’S ORAL-HEALTH-RELATED QUALITY OF LIFE: A COMPARATIVE CROSS-SECTIONAL STUDY

Sun, 31 Mar 2024 00:00:00 +0000

Background: Despite reductions in dental caries experience in developed countries, early childhood caries remains the most prevalent health problem in developing countries. This has a direct impact on the oral health-related quality of life of both children and parents. The objective of this study was to examine the impact of comprehensive dental treatment under general anaesthesia on Oral health-related quality of life in children, using a parental and caregiver perception questionnaire. Methods: A comparative study was conducted in the Children Hospital, Pakistan Institute of Medical Sciences, Islamabad from July to December 2015. A total of 40 children were enrolled in the study. The oral health-related quality of life questionnaire was completed by either parent/caregiver at the initial and follow-up visits after 4-8 weeks of treatment under general anaesthesia. Results: The mean age of all the enrolled children was 5.7±1.7 years. Among 40 children, 55% (22) were girls and 45% (18) were boys. A highly significant reduction was observed between the pre and post-treatment P-CPQ total scores from 76.9±15.8 to 13.3±9.5 with a p-value <0.0001. Regarding the P-CPQ domains, a significant reduction from the pre- to post-treatment scores was observed for oral symptoms; functional limitations, emotional well-being, and social well-being with a p-value <0.0001. Conclusion: The oral health-related quality of life was significantly improved after comprehensive treatment under GA. The findings of this study may be utilized to improve future guidelines and betterment of dental health of children by health care providers and initiatives for future health programs.

Efficacy and safety of supine percutaneous nephrolithotomy in obese patients.

Thu, 28 Mar 2024 00:00:00 +0000

Objectives: The efficacy of percutaneous nephrolithotomy in obese patients.

Patients and Methods: We retrospectively reviewed the patients who underwent PCNL between January 2015 and December 2019. A total of 150 patients were enrolled. The patients were categorized into two groups according to BMI: <30 kg/m2 (group 1, non-obese) and > 30 kg/m2 (group 2, obese). The stone clearance rate, operation time, duration of hospital stay, Postoperative analgesic use, and postoperative complications were compared among groups. The chi-square test was used to analyze variables and Complications were graded according to the Clavien–Dindo classification system.

Results: The BMI values of 110 patients were lower than 30 kg/m2, while 40 patients' BMI values were higher than 30 kg/m2. There was no significant difference between operation time, fluoroscopy time, number of access points, or access sites when the two groups were compared. No significant difference was found in the total length of hospital stay, hemoglobin drop, or complication rates. Immediate stone-free rates were 81.8% in the non-obese group and 75 % in the obese group (p = 0.21).

Conclusion: In a retrospective study of 150 patients undergoing supine PCNL, the efficacy was not different between non-obese and obese patients. This is the first study evaluating these outcomes for PCNL performed under the ERAS protocol in the supine position. Further multicenter and prospective studies are required to verify these findings.

Introduction.

Obesity is an increasing health concern, affecting 39% of the population. In Qatar, in recent years, the obese population contributed 35.9% of men and 46.1% of women. Qatar's obesity prevalence is higher in the region. The diet, rich in animal protein, high in oxalate, low in calcium, and the dry subtropical desert climate are risk factors for urolithiasis in Qatar. (1) Obesity and weight gain also pose a high risk of urolithiasis. (2) Multiple modalities are available for kidney stones, including extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PCNL). However, obesity is a factor in the failure to fragment renal stones by extracorporeal shock wave lithotripsy. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for renal stones if the stone size is above 2 cm and has been universally endorsed by American, European, and other national guidelines. (3-5) The impact of body mass index (BMI) on the outcome of PCNL is still controversial. Recently, a study by the Endourological Society (CROES) reported that the PCNL had a lower stone-free rate and prolonged operative time in obese patients. (6)

Obesity has generally been considered a factor that affects the outcomes of PCNL procedures due to anesthesia-related issues, imaging issues, and technical aspects of endoscopic surgery. Several studies have evaluated the impact of body mass index (BMI) on PCNL outcomes, but in most of these studies, PCNL has been performed in the prone position. (7) Enhanced recovery after surgery (ERAS) has been introduced in endourology to improve postoperative outcomes by reducing the length of stay (LOS). ERAS is also helpful in reducing stress, morbidity, and recovery time. (8) A few studies have been published about the effect of BMI on the outcomes or complications of PCNL in the supine position. The purpose of the current study was to evaluate the impact of obesity on the outcomes of complete supine PCNL under the umbrella of the ERAS protocol in a single center. To the best of our knowledge, this is the first study on a specific topic.

Material and Methods.

We retrospectively collected a database of all patients who underwent PCNL from January 2015 to December 2019 at our center. For this study, we selected only adult patients who underwent PCNL in the complete supine position. The patients were stratified into two groups. according to their BMI at the time of surgery: < 30 kg/m2 (group 1, non-obese) and > 30 kg/m2 (group 2, obese). Preoperative evaluation of the patients included age, sex, size of the stone, preoperative renal parameters, and stone history. The Intraoperative and postoperative data contained operation time, fluoroscopy time, transfusion rate (intra and until discharge), stone-free status, the need for the second procedure (either PCNL or ESWL), complications, analgesic use, and duration of hospital stay. The immediate success rate was defined as "no residual stone."Complications were classified. according to the Clavien-modified system. Enhanced recovery after surgery (ERAS ) protocol for a smooth recovery for the different surgical procedures includes (Cho module, Gabapentin 600 mg, Celecoxib 200 mg, Paracetamol 1gm, Dexamethasone 8mg, Vte prophylaxis, single-dose antibiotic) as preoperative. The surgical technique was similar in all cases. Patients were positioned in a supine position completely. Initially, cystoscopy was performed with a 6F open-ended ureteral catheter placed in the upper ureter or kidney. Subsequently, retrograde pyelography and puncture were performed under fluoroscopic or ultrasonic guidance. The 18-gauge needle was used for puncture. A hydrophilic guidewire was passed into the ureter. In the case of puncturing multiple tracts, first gird wires are placed, and then dilation is done. Tract dilation was accomplished with sequential fascial dilators, and a 30F Amplantz sheath was used to proceed. The stones were broken using an ultrasonic lithotripter. An 18F nephrostomy tube was placed at the end of the procedure in cases of moderate bleeding, residual stones, renal pelvis perforation, or multiple Otherwise, a Double-J stent was placed and left indwelling for 5–14 days with or without string, according to procedure. Operation time was recorded from the beginning of flexible cystoscopy to the end of nephrostomy tube placement or stent placement. Some PCNL procedures are tubeless based on the urologist’s decision. A postoperative plain abdomen X-ray would be done to confirm stone clearance and the position of the nephrostomy. If the patient had no fever within 24 hours after the operation, the Foley catheter would be removed and the nephrostomy would be clamped. The time of nephrostomy removal depended on the clinical condition and the judgment of the doctor. Statistical analysis was carried out in the form of mean and standard deviation. Student t-tests were performed to see significant mean levels between the two groups and Chi-square tests were applied to see the association between the two groups. A P value of 0.05 was considered a significant level. SPSS 20.0 statistical package was used. for the analysis.

Results.

The study included 109 male patients (72%) and 41 females. Patients (28%) with a mean age of 49 ± 12.9 years (Range: 22–72 years) As for the distribution of stone characters, The proportions were 32%, 48%, and 18% in the ureteropelvic junction or stone in one calyx, partial staghorn stone, and complete staghorn stone, respectively. Right-side renal stones accounted for 40%, and the left side for 60%. The mean stone size was 22.6 mm ± 8.3 mm. The mean BMI was 26.41 ± 3.53 kg/m2. in the non-obese group and 35.4±3.8 in the obese group. Among the two groups, in terms of age, there were no significant differences observed, in gender, stone character, laterality, stone size, history of diabetes mellitus or chronic kidney disease, and preoperative pyuria. Among Group 1 patients, 65 (59.1%) had simple stones. while 45 (40.8%) had complex stones. In group 2, 28 (70%) had simple stones, and 12 (30%) had complex stones. There was no statistically significant difference observed between the two groups in terms of the complexity of the stones. The mean duration time of operation was 105±36.4 minutes in the non-obese group and 109±42.4 minutes in the obese group. The mean duration of operation was not statistically significantly different between the two groups. The mean duration of fluoroscopy was 5.4±3.6 minutes in Group 1 patients and 5.8.4±4.9 minutes in Group 2. patients, displaying no statistically significant difference between the two groups (p = 0.54). In the non-obese group, 96 patients had one, 13 had two, and one had three accesses. In the obese group, however, 32 patients had one, 7 had two, and 01 had three accesses. There were no significant differences observed in terms of the number of accesses (p = 0.510). Due to intraoperative hemorrhage resulting in hypotension, a blood transfusion was given to two patients (1.81%) in group 1 and one patient (2.5%) in group 2. There were no significant differences observed in intraoperative blood transfusion (p=0.79). Except for hemorrhage, no other intraoperative complication was observed in the patients. Fever (> 38 oC) was determined before discharge in 13 patients in the non-obese group and 5 patients in the obese group, and they were appropriately treated before being discharged from the hospital. No significant difference was observed in terms of postoperative fever between the groups (p = 0.91). None of the Patients developed sepsis or died from operation-related complications. When the groups were evaluated in terms of operation success, postoperative residual stone fragments were observed in 18 patients (16.36%) in group 1 and 5 patients (12.5 %) in group 2. There was no significant difference. in operative performance between the groups (p = 0.21). The Groups were also evaluated for additional interventions. Eleven Patients in the non-obese group required additional interventions post-discharge. Double Stents (DJS) were inserted in three patients due to wound sites. discharge or severe colic pain. Ureteroscopy (URS) was performed on three patients for treatment of the ureteral stones and five patients with ESWL. In Group 2, however, a total of 4 Patients required additional interventions. three patients with ESWL. One patient underwent URS due to a ureteral stone. The requirement for additional intervention was considered a Clavien grade 3 complication, and there was no significant difference between the two groups (p = 0.922).

Discussion.

Obesity has affected the population of both developed and developing countries through reduced physical activity and increased calorie intake. Particularly high- income countries have displayed higher rates of increase in obesity in the last two decades. (9) The incidence of health problems such as metabolic syndrome, cardiovascular disease, malignancy, and renal calculus also increased in the community with the increased prevalence of obesity. (10) PCNL remains the gold standard for patients with large renal stones. A few studies reported the impact of obesity on PCNL in the prone position. Studies have shown that prone PCNL in normal-weight, obese, and super-obese individuals has similar outcomes. (11-12) The CROES Percutaneous Nephrolithotomy Global Study reported a longer operation time, an inferior stone-free rate, and a higher reintervention rate in obese patients than in nonobese patients. Standard-prone positioning affects the airway in overweight patients and may also impair venous blood flow. (13) Over the last two decades, the supine position for PCNL has gained acceptance and popularity as an alternative to the standard historical prone position. (14) The main benefit of the supine PCNL is that it can be carried to protect the airway. Supine PCNL offers a safe way for patients with compromised cardiorespiratory function and morbidly obese patients to breathe. (15) Different studies have shown the supine PCNL safety and effectiveness. (14)

There are a few studies comparing supine and prone PCNL in obese patients. In another study, outcomes of prone and total supine position PCNL in 42 obese patients showed results of stone-free (83.3% vs. 78.1%; p = 0.74) and complication rates (33.3% vs. 31.3%; p = 0.77), but significantly shorter operative time, lower transfusion rates, and a shorter hospital stay (p = 0.014) in the supine position group than in the prone position group. (16) However, anesthesia-related problems can be seen in obese patients. Respiratory complications like a decrease in total lung capacity may occur in the prone position, and extubation difficulties may also occur in obese patients. (17) In some centers, to minimize the complications of PCNL, it is carried out in a supine position. (18) ERAS Enhanced recovery after surgery is a protocol for a smooth recovery for the different surgical procedures it includes (Cho module, Gabapentin 600 mg, Celecoxib 200 mg, Paracetamol 1gm, Dexamethasone 8mg, Vte prophylaxis, single-dose antibiotic).

Our study had some limitations. It was retrospective and might be biased by management strategies and patient allocation in the absence of stone analysis results. Furthermore, the surgeons who performed supine PCNL were not the same ones and might be biased by the surgeon's experience. However, to the best of our knowledge, this is the first study in Qatar. We also extended the outcome with the ERAS protocol, which has not been reported in previous studies.

Conclusions Our study has demonstrated that the efficacy and safety of the supine PCNL procedure were similar in obese and nonobese groups. Supine PCNL under the cover of the ERAS Protocol seems to be a safe and efficacious option for obese patients with renal stones.

Conflicts of interest: This study has no conflict of interest to be declared by any author.

Acknowledgments: We would like to acknowledge the study participants, data collectors, and supervisors who participated in the study.

AUTHORS' CONTRIBUTION;

KHB: Acquisition, drafting work, and agreement to be accountable for all aspects of work. AAC, AAS, HMA, AHS, WSB, and FSG: Conception and design of the work. SA, AMS, NS, KMA, Analysis, and data interpretation. SA, AMS, NS, and KMA, Critically revised for important intellectual content. SA, AMS, NS, KMA, Final approval of the version to be published.

COMPARISON OF THE OUTCOMES OF ENHANCED RECOVERY AFTER SURGERY (ERAS) VS CONVENTIONAL CARE IN ELECTIVE COLORECTAL SURGERY

Muhammad Tariq Iqbal, Atta Ullah Jatt, Fawad Mueen Arbi — Mon, 15 Apr 2024 00:00:00 +0000

Background: Uncontrolled cell development in the colon, rectum, or appendix is the cause of colorectal cancer, sometimes referred to as colon cancer, rectal cancer, or bowel cancer. Its incidence is higher in developed countries than in developing ones. About 75–95% of cases occur in individuals without significant genetic risk. The aim of Enhanced Recovery After Surgery (ERAS) or fast-track surgery involves the use of several perioperative strategies to facilitate better surgical conditions to achieve faster recovery of the patients which has shown better outcomes in different surgery types. This study aims to compare the outcome of ERAS vs conventional care in elective colorectal surgery. Methods: In this randomized controlled trial, 60 patients undergoing elective colorectal surgery were assessed by dividing them into two groups. Group A patients followed ERAS protocols, while Group B patients followed conventional care techniques. Time for bowel sounds and first flatus were noted. Mean hospital stay was recorded for each patient from operation to discharge. Patients were followed for 4 weeks for surgical site infection assessment. Results: The mean time to return bowel sounds in Group A was 20.63±2.66 hours while in Group B was 27.0±2.07 hours (p-value =0.0001). The mean time to passage of the first flatus in Group A was 18.67±2.38 hours while in Group B was 25.93±2.88 hours (p-value =0.0001). The mean hospital stay in Group A was 3.37±1.75 days while in Group B was 8.30±1.68 days (p-value =0.0001). Surgical site infection was found in 04 (13.33%) patients in group A while in group B, it was found in 09 (30.0%) patients with a p-value of 0.1172. Conclusion: This study concludes that the outcome of enhanced recovery after surgery (ERAS) is better than conventional care in elective colorectal surgery.

IRON DEFICIENCY WITHOUT ANEMIA IN COPD PATIENTS: ASSESSING EXERCISE CAPACITY AND EXACERBATION FREQUENCY

Mon, 04 Mar 2024 00:00:00 +0000

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health challenge with significant morbidity and mortality. Iron deficiency, including non-anaemic iron deficiency (NAID), has been identified as a potential comorbid in COPD, affecting patient outcomes and disease severity. This study aimed to investigate the prevalence and impact of iron deficiency on the severity and clinical outcomes in COPD patients. Methods: In this descriptive cross-sectional study, 289 individuals diagnosed with COPD were enrolled and underwent comprehensive medical assessments, including haematological tests and spirometry from December 2019 to December 2023. The study focused on measuring iron levels, exercise capacity, and exacerbation frequency, comparing iron-deficient and non-iron-deficient groups. Results: The study found that 46.7% of participants had iron deficiency. Those with iron deficiency showed significantly lower exercise capacity as measured by the six-minute walk distance and experienced a higher frequency of yearly COPD exacerbations. However, no significant differences were observed in airflow limitation and the overall quality of life between the iron-deficient and non-iron-deficient groups. Conclusion: The findings suggest that iron deficiency, particularly NAID, is associated with a more severe progression of COPD, characterized by reduced exercise capacity and increased exacerbation frequency. These results highlight the importance of considering iron deficiency in the management of COPD to potentially improve patient outcomes. Keywords: Chronic Obstructive Pulmonary Disease (COPD); Iron Deficiency; Non-Anaemic Iron Deficiency (NAID); COPD Exacerbations; Exercise Capacity in COPD; COPD Management Strategies

USE OF DIFFERENT ANTHROPOMETRIC TOOLS IN GENDER ANALYSIS OF MALNUTRITION IN DIVISION BAHAWALPUR

Muhammad Babar Alam, Rubeena Zakar, Muhammad Zeeshan Haroon — Wed, 27 Dec 2023 00:00:00 +0000

Previous studies highlighted that CIAF is better tool for malnutrition assessment which screen more children compared to other anthropometric approaches like MUAC, BMI for age, conventional indices (Stunting, Wasting and Underweight). In literature, none of the study has mentioned CIAF performance by gender in comparison with other anthropometric approaches. The study solves this puzzle, whether CIAF has the same performance in gender analysis too or not. Data from 1152 homes gathered using purposive random sample approach. The CIAF detects more malnourished children (63%) compared to other methods. Results show that male children in the study region had a greater frequency of malnutrition than female children. The results of the chi-square showed thatage and gender of the child have a significant relationship with CIAF than other approaches.The CIAF is a superior instrument for assessing child malnutritional status since it detects more malnourishedchildren even with gender analysis too.

COMPARISON OF DIFFERENT TREATMENT MODALITIES OF CHELATION THERAPY IN BETA THALASSEMIA MAJOR PATIENTS

Ghazal Usman, Mahfooz ur Rehman, Shifa Khalil, Muhammad Sarmad Hafeez — Mon, 05 Feb 2024 00:00:00 +0000

Background: Thalassemia has high prevalence and carrier rate of 8 – 10% in Pakistan, repeated blood transfusions lead to iron deposition in organs. In this Prospective study we have compared the efficacy of three chelation regimens being used in our country. It has been conducted at PBTS, Fatmid Foundation and Children Hospital Lahore. Methods: 60 thalassemia major patients, were divided into 3 groups according to their mode of chelation. Patients in group I were on oral iron chelator deferiprone, 7 days per week. Thalassemics in group II were on parenteral iron chelator deferoxamine given subcutaneously for 4 days in a week, and group III patients were on combination therapy, deferiprone for 5 days & deferoxamine given twice weekly. The assessment of chelation was done by measurement of serum ferritin and 24 hour urinary iron excretion at the start of study and then after six months of follow up. To assess the hepatic iron, hepatic MRI were also performed. Results: Ferritin levels were maximally decreased in group II, followed by group III, with no significant reduction in group I. However statistically significant difference in mean urinary iron excretion (increased) was seen in group III. The hepatic iron was very high in all three groups as shown by the hepatic MRI. Conclusion: Combination chelation therapy is the most effective chelation therapy in iron overloaded patients. It helps improve the compliance and increases urinary iron excretion. Patients on DFX have lowest degree of hepatic siderosis even though it is considerably higher than normal population.

PREVALENCE AND DETERMINANTS OF DEPRESSION AMONG AMPUTEES IN QUETTA REGION

Mon, 05 Feb 2024 00:00:00 +0000

Background: Depression is increasingly diagnosed in the general population today. The loss of a limb through amputation, which can result in disfigurement, may also contribute to the development of depression despite pre-operative counselling. Understanding the factors associated with depression in individuals with limb amputation is important to effectively identify and manage this psychological condition. The objective of this study was to identify the factors associated with depression in individuals who have undergone limb amputation. Methods: A descriptive cross-sectional study was conducted in Quetta City from May to July 2018. Data were collected using a structured, respondent-cantered questionnaire based on the Hospital Anxiety and Depression Scale (HADS). Results: Females were more affected as 5 out of 7 (71.42%) were depressed compared to 32 out of 47 (68%) males. The study found a statistically significant association between depression and marital status (p-value of 0.047) as well as amputation (p-value of 0.039). These results suggest that both sociodemographic factors, such as marital status, and the experience of amputation are associated with the development of depression in individuals with limb amputation. Conclusion: Amputation is significantly associated with the level of depression among amputees, and sociodemographic factors, such as marital status, also play a role in the development of depression. Therefore, it is recommended to conduct yearly screenings for depression following an amputation to effectively identify and manage this psychological condition. Further research and interventions are needed to address the mental health needs of individuals with limb amputation and implement strategies for depression prevention and management in this population.

EXPERIENCES, PERCEPTIONS, AND RECOMMENDATIONS FOR FACULTY DEVELOPMENT PROGRAMS IN HEALTH PROFESSIONS EDUCATION: A QUALITATIVE STUDY

Tue, 27 Feb 2024 00:00:00 +0000

Background: Faculty development programs (FDPs) in health profession education (HPE) impact teaching in different ways. There has been limited literature on the impact of such programs in developing countries. This qualitative study explores the experiences, perceptions, and recommendations of faculty attending these FDPs. Methods: A qualitative case study involving purposively selected public and private medical college faculty members were enrolled. Semi-structured interviews were conducted with 14 faculty members across the country. Thematic analysis was done using ATLAS. Results: The study revealed three main themes. The first, "experiences with FDPs," has three subthemes, i.e., faculty limited engagement, key areas of FDPs and the need for interactivity and collaboration. The second theme is based on "participants' perception", with two subthemes: key indicators and how teaching skills are improved and some challenges versus recommendation, as the third theme emerged from the data analysis. Conclusion: In the current context, FDPs, as experienced by medical professionals, emphasise the need for administrative facilitation, tailored and technology-driven flexible programs that foster faculty exposure, interactivity, and collaboration. The perceptions ensued in using innovative strategies within the FDPs with feedback and evaluation. However, recommendations target the national accreditation bodies or institutions and individual schools to devise training centres as per needs assessment. Future studies should develop and validate a tool based on key indicators for the proper evolution of the effectiveness of FDPs.

SKIN ANTISEPSIS PRACTICES FOR CENTRAL NEURAXIAL BLOCKADE

Abdullah Nisar, Azhar Rehman, Ali Sarfraz Siddiqui — Mon, 05 Feb 2024 00:00:00 +0000

Background: Skin antisepsis is essential before the central neuraxial blockade. Various antiseptic solutions are in clinical use, like povidone-iodine, alcohol, or chlorhexidine. This study was conducted to assess current practices for skin antisepsis before central neuraxial blockade and observe the compliance of anaesthesiologists with international standards in Teaching Hospitals in Karachi, Pakistan. Methods: A cross-sectional study was conducted on all anaesthesia faculty members, working in Teaching Hospitals in Karachi from March to May 2022. Demographic data included institutional setup and current position at the institution. The type of solution used for skin anti-sepsis for the central neuraxial blockade, method of application, and subsequent practices of anti-sepsis were asked. Recommendations for the skin anti-antisepsis and the reason for opting for their choice of solution and practices were also assessed. Stratification analysis was then performed to observe the effect modifiers of study variables. Results: Data from seventy faculty members were analyzed. Povidone-Iodine was the most frequent solution used for skin antisepsis. Alcohol-based Chlorhexidine 2% and 0.5% were the alternative choices. The application method prevalent was Sponge/swab with Gallipot (94.3%). Major reasons to opt for their choice of solution were personal preference, cost-effectiveness, and availability of the solution in their Institute. Fifty percent of physicians considered Chlorhexidine 2% as the recommended solution for central neuraxial procedures. Regarding sterility, over ninety percent adhered to the recommended practices. Conclusion: Povidone-Iodine is currently the most frequent solution used for skin antisepsis before central neuraxial blockade by anaesthesiologists. The recommended solution (Chlorhexidine) was not in clinical practice due to personal preference, cost-effectiveness, or unavailability.

RELATIONSHIP BETWEEN LOWER URINARY TRACT SYMPTOMS AND TREATMENT-RELATED BEHAVIOR IN HAZARA DIVISION

Thu, 14 Mar 2024 00:00:00 +0000

Background: Lower urinary tract symptoms (LUTS) adversely affect the quality of life and are usually under-reported because of a stigma associated with these symptoms. Unless specifically probed for these symptoms, most patients do not report Lower urinary tract symptoms. This study focused on the treatment seeking behavior of otherwise healthy individuals who had LUTS. The study aimed to determine the relationship between lower urinary tract symptoms and treatment-related behaviours among adults in the Hazara Division. Methods: This was a descriptive cross-sectional, questionnaire-based study of healthy attendants of patients admitted at a private medical center for any reason who were enrolled in this study and were interviewed using a simple questionnaire after obtaining informed consent. The patients were administered validated tools such as OAB-8 and IPSS. Results: Overall, 23.5% of study participants reported LUTS. Among the 968 study participants, 530 reported having LUTS less than half the time and 438 reported LUTS more than half the time during the past 3 months. Over 23.5% of patients sought any type of treatment for their symptoms. the likelihood of seeking medical attention was more in males experiencing issues such as urgency with distress (aOR 2.21 (1.11–4.05) CI 95%), frequency with distress (aOR 1.88 (1.01–4.21) 95%CI), slow urinary stream with distress (aOR 2.33 (1.13–4.49) CI 95%), hesitation (aOR 1.81 (1.02–2.15) CI 95%), and feeling of incomplete bladder emptying (aOR 3.13 (1.38-4.95) CI 95%). Similarly, females with symptoms like urgency with a fear of urine leak (aOR 5.33 (1.67–10.93) CI 95%), frequency (aOR 4.88 (1.29–9.94) CI 95%), urgency with distress (aOR 6.11 (2.33–13.20) CI 95%), and intermittency (aOR 2.32 (1.33–3.78) 95% CI), were more prone to seeking medical help. Conclusion: There is marked under-utilization of treatment for LUTS. Physicians need to adopt a proactive approach to identifying these symptoms and offering treatment.

ENHANCED RECOVERY AFTER CAESAREAN SECTION – AN IMPROVED PATHWAY THAN CONVENTIONAL CARE FOR REDUCING HOSPITAL STAY

Mon, 05 Feb 2024 00:00:00 +0000

Background: With the help of an evidence-based approach called “Enhanced Recovery After Surgery” (ERAS), patients can receive standardised perioperative care and recover more quickly. Many surgical specialties, such as orthopaedics, gynaecological onco-surgery, breast surgery, urology, and colorectal surgery, use ERAS protocols extensively. Improved postoperative recovery has been shown to be beneficial in lowering hospital stays, costs, and increasing patient satisfaction. This study sought to determine whether the application of an enhanced recovery after surgery (ERAS) protocol for patients having an elective caesarean section would improve the patients’ postoperative status regarding pain management, length of stay in the hospital and expenses associated with complications. Methods: A prospective study was conducted in PAF Hospital Faisal, Karachi. Women scheduled for elective caesarean sections were enrolled in the cross-sectional study from February 2023 to July 2023, and they were compared to women who had caesarean sections during the same time period and received conventional perioperative care. Patients with medical or surgical comorbidities, as well as women who had emergency or urgent caesarean sections, were excluded. The surgical method was same in both ERAS and non-ERAS arms. Intravenous hydration was used to achieve a specific purpose. After 4 hours, liquids were introduced, followed by solids after 6 hours. Intravenous paracetamol and intramuscular diclofenac were given regularly. After 6-8 hours, the Foleys catheter was withdrawn. The conventional care group fasted for 6 hours before and after surgery. The catheter was left in place for 24 hours, and 2500 ml of intravenous fluids were administered on the first day, followed by 1000 ml on the second. The length of hospital stay was determined by clinical criteria and the discretion of the care providers. Results: In contrast to the conventional care group, the ERAS arm experienced a much shorter post-operative hospital stay. (p-value= 0.001; 33.42 vs. 61.30 hours). The patient quickly recovered due to early eating, early ambulation, early catheter removal, multimodal pain management, and pre-emptive analgesia and antibiotic administration. Conclusion: The ERAS protocol has been shown to be beneficial in lowering postoperative pain and nausea, the average cost of hospitalization, and improving patient satisfaction. It seems to be worth implementing this protocol widely among patients undergoing elective caesarean sections

PECTORALIS MAJOR MYOCUTANEOUS FLAP SUCCESS RATE IN SURGICAL MANAGEMENT OF ORAL CANCER

Saeed Ullah Shah, Hina Jabeen, Fatima Waseem, Haleema Dilawar — Thu, 29 Feb 2024 00:00:00 +0000

Background: The recurrence rate of Oral squamous cell carcinoma is between 26.5% and 56.3% of cases. The majority of handling failures are confined & local-regional. However, there is debate regarding the best course of action for these patients with recurring oral Malignancy. The objective of the study was to assess the efficacy of the flap in the reconstruction of oral cancer patients and the complications that can result from it. Methodology: The study was conducted in Zia-Uddin Hospital, Karachi, Pakistan from 2020 to 2022. Forty patients of recurrent oral cancer, who underwent salvage surgery with a pectoralis major myocutaneous flap were included in the study. Information was taken from the case notes, & the clinical follow-up of the patients were done between one month and one year. Results: The surgery had an 80% overall success rate. Twenty patients (57.1%) experienced difficulties, including 17 (48.6%) who had flap-related issues. Seven patients (20%) experienced problems unrelated to the flap, such as temporomandibular joint pain and haemorrhage of the chest incision. 9 patients (25.7%) experienced major difficulties, compared to 8 patients (22.9%) who experienced minor complications. Conclusion: For the dependable restoration of significant soft tissue abnormalities brought on by the excision of recurrent oral cancer, the pectoralis major myocutaneous flap was found to be a good option. The main issues were related to the reconstruction site. Salvage surgery helps a lot of patients, and some of them can live for two to four years after the procedure.

EXPLORING THE IMPACT OF INTERVENTIONS ON THE PSYCHOLOGICAL WELL-BEING OF PARENTS OF CHILDREN WITH DOWN SYNDROME IN KHYBER PAKHTUNKHWA, PAKISTAN

Sidra Ali, Syeda Kaniz Fatima — Wed, 14 Feb 2024 00:00:00 +0000

Background: Despite the significant advancements in medical and educational fields, children with Down syndrome and their parents still encounter numerous challenges in underdeveloped countries like Pakistan, particularly in the Khyber Pakhtunkhwa area. This study hypothesized that prolific intervention programs instituted to support parents in dealing with these challenges will experience a drop in parental stress levels. Methods: Cross-sectional descriptive research was carried out using a Purposive sample approach between 15^th June 2020 and 05^th January 2023 to evaluate the impact of several intervention programs for parents at different special education centers in Mardan, Charsada, Naushera, Swabi, and Peshawar. The research included 105 parents who were approached through these intervention programs and the success of these programs were evaluated across five dimensions: Social, psychological, cognitive, religious, and educational aspects. The interview-based parenting Intervention Questionnaire (IBPIQ) was used to gather information concerning the efficacy of these interventions, and the parental stress scale was administered to measure parental stress. Results: The results of the study showed that there is no significant correlation between Parental intervention programs and reduced levels of parental stress. While a weak positive correlation (social impact: 0.212) was found whereas psychological p-values = 0.065, educational p-values = -0.058, cognitive p-values = -0.067, and religious impact p-values =0.101 were non-significant. Conclusion: After an extensive review of various intervention programs for parents of children with Down syndrome in Pakistan, this study concluded that these Intervention programs did not significantly benefit the parents. As a result, stress levels among Down syndrome’s parents did not lessen, regardless of their involvement in these interventions.

USING ARTIFICIAL INTELLIGENCE AND MACHINE LEARNING APPROACHES TO ENHANCE CANCER THERAPY AND DRUG DISCOVERY

Tue, 27 Feb 2024 00:00:00 +0000

This paper looks at how AI and machine learning have been applied over the last ten years to the development of anti-cancer drugs. By speeding up the synthesis of more desirable compounds and the identification of new ones, artificial intelligence (AI) has demonstrated substantial contributions to the research and therapy of anti-cancer therapies. Future developments in human cancer research and treatment are anticipated to be significantly influenced by AI. Protein-interaction network analysis, drug target prediction, binding site prediction, and virtual screening are examples of innovative techniques. Drug design and screening are enhanced by machine learning, and the use of multitarget drug development approaches has made it possible to develop cancer treatments with fewer side effects. AI does, however, have several drawbacks, such as a heavy reliance on data and a narrow scope of explanation. Interpretable AI models, which combine data and computation in AI-assisted cancer treatment research, will be the new development path in the future. For more than thirty years, computer-aided drug design techniques have been a key component in the advancement of cancer therapies. Artificial intelligence is a new and powerful technology that has the potential to speed up, lower the cost, and improve the efficacy of anti-cancer therapy development. This work is a narrative review that examines numerous uses of AI-based techniques in the development of anti-cancer medications. We go on to explain the underlying ideas of these techniques as well as their benefits and drawbacks. In addition, we aggregate a multitude of databases, such as the pharmacological, chemical compound, omics, and epigenomics databases. They can be taken into consideration and modified to suit the needs of other researchers.

EPIDEMIOLOGICAL PROFILE AND FETO-MATERNAL OUTCOME OF TWIN PREGNANCY: A PROSPECTIVE OBSERVATIONAL STUDY

Mon, 26 Feb 2024 00:00:00 +0000

Background: Twin pregnancies are complex and have often been associated with various complications affecting both mother and baby. Understanding the different maternal and foetal outcomes can provide crucial insights for healthcare practitioners. The aim was to determine the maternal and foetal outcomes of twin pregnancies and understand the factors influencing these outcomes. Methods: A prospective observational study was conducted with women experiencing twin pregnancies of more than 28 weeks gestation. Patients were followed up until 7 days postnatally and the outcomes were analyzed against various parameters such as age, foetal presentation, and mode of delivery. Statistical software SPSS V 26 was utilized for data analysis and ethical considerations were duly met. Results: A total of 22,922 deliveries were recorded, with 195 being twin pregnancies. Most twin deliveries were among women aged 20–29 years, with nearly half being first pregnancies. Major findings include a prevalence of preterm deliveries (59.6%), a high incidence of maternal anaemia (54%), and a significant number of neonatal intensive care unit (NICU) admissions (45.45%). No statistically significant difference was observed in the feto-maternal outcomes about the mode of delivery or booking status. Conclusion: Twin pregnancies are associated with a higher likelihood of preterm deliveries, maternal anaemia, and newborn NICU admissions. Importantly, the mode of delivery and booking status did not significantly affect the feto-maternal outcomes. This study underscores the need for individualized patient care in managing twin pregnancies.

ADMISSION FRAILTY SCORE AS A GOOD CLINICAL SUBSTITUTE OF SOFA SCORE TO PROGNOSTICATE POST-PERCUTANEOUS CORONARY INTERVENTION PATIENTS ON ADVANCED LIFE-SUPPORT

Mon, 05 Feb 2024 00:00:00 +0000

Background: This study aimed to assess and compare the prognostic value of frailty score (FS), Sequential Organ Failure Assessment (SOFA) score, and additive of FS and SOFA score, at the time of admission to the coronary care unit (CCU), for the prediction of short-term poor prognosis in post-myocardial infarction (MI) patients, requiring advanced life-support. Methods: A cohort of post-MI patients admitted to CCU. The FS and SOFA score were obtained at the time of CCU admission. The prognostic value of FS, SOFA score, and FS+SOFA score was assessed to predict in-hospital and short-term follow-up mortality. Results: The study sample consisted of 312 patients: females were 27.2% (85), and the mean age was 60.32±11.51 years. A concordance rate of 51.8% was observed between admission FS (≥3) and SOFA score (≥9). A total of 67.3% (210) patients were categorized as moderate to severely frail (≥3), while the SOFA score identified 26.0% (81) high-risk (≥9) patients. The receiver operating characteristics (ROC) analysis showed an area under the curve (AUC) of 0.707 [0.638–0.776], 0.764 [0.704–0.825], and 0.783 [0.724–0.842] for in-hospital mortality and 0.684 [0.621–0.746], 0.718 [0.659–0.778], and 0.744 [0.687–0.801] for 180-day cumulative mortality against FS, SOFA, and FS+SOFA score, respectively. A hazard ratio of 2.75 [1.61–4.71] and 2.51 [1.68–3.75] were observed for mortality during 180-day follow-up among patients with FS ≥3 and SOFA score ≥9, respectively. Conclusion: CCU admission Frailty Score is a good clinical substitute for SOFA score for an early prognostication of post-MI patients on advanced life-support.

THE EFFECT OF SUBCUTANEOUS EPINEPHRINE DOSAGE ON BLOOD LOSS IN SURGICAL INCISION

Mon, 05 Feb 2024 00:00:00 +0000

Background: Vasoconstrictive drugs are increasingly frequently used to stop bleeding during cosmetic and reconstructive surgeries, especially subcutaneous epinephrine^7.As far as we are aware, no studies have been conducted on how adrenaline affects bleeding in patients having supraventricular flap surgery so we planned this study to find out the impact of various epinephrine dosages on the amount of bleeding in surgical incisions among participants undergoing supraclavicular flap surgery. Methods: This single-blinded randomized controlled trial was performed at the Department of Plastic Surgery, Ruth Pfau Civil Hospital, from September 2022 to September 2023. Group 1 was given 0.9% saline with an epinephrine concentration of 1:200,000. Group 2 was administered a 0.9 % saline solution containing a 1:400,000 epinephrine concentration. Group 3 was given just 10 ml of 0.9 % saline (control group). Bleeding was measured for 5 minutes by volumetric method. Results: Patients’ age (p=0.221), gender (p=1.000) and surgery site (p=0.265) were not significantly different among the three study groups. Mean blood loss volume for group 1, group 2 and group 3 was 15.8 0±5.37mL, 19.80±8.44mL and 57.20±14.14mL respectively. On post-hoc analysis for total blood loss volume, significant differences were seen between Group 1 and Group 3 (p<0.001), and Group 2 and Group 3 (p<0.001). Conclusion: The present study showed that blood loss was significantly lower among both of the groups of adrenaline but blood loss from the two doses of epinephrine did not differ significantly.

COMPARISON OF POSTOPERATIVE PAIN WITH AND WITHOUT PECTORAL BLOCK IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY

Zenab Noorain, S H Waqar, Saad Ali Shah, Shahabul Huddah, Sajid Ali Shah — Mon, 05 Feb 2024 00:00:00 +0000

Background: Modified Radical Mastectomy is associated with significant acute postoperative pain. If this pain is not managed properly most patients will develop chronic post-mastectomy pain, which reduces quality of life. Pectoralis (PECS) block is effective in reducing pain and the consumption of analgesia in the post-operative period. The objective was to compare mean post-operative pain with or without pectoral (PECS) block in females undergoing modified radical mastectomy under general anaesthesia. Methods: A randomized controlled trial was done in the Department of General Surgery at Pakistan Institute of Medical Sciences, Islamabad. Patients who fulfilled the inclusion criteria and underwent modified radical mastectomy were included in the study. A total of 60 patients, were randomly divided into two equal groups, the PEC group and without PEC group. After surgery, patients were shifted to the postoperative care unit and were assessed for postoperative pain after 6 and 12 hours. Data was collected and descriptive analysis was done using SPSS version 22. Results: The mean age and BMI of the patients was 51.52±10.29 years and 24.1±3.94 kg/m², respectively. Among patients from the PEC group, the mean post-op pain after the 6 hours was 2.13±0.571 while in the without PEC group, the mean post-op pain was 2.67±1.093 (p-value=0.021). Similarly, in patients from the PEC group, the mean post-op pain after the 12 hours was 1.20±0.407 while in the without PEC group, the mean post-op pain was 1.63±0.615 (p-value=0.002). Conclusion: Post-operative pain with PEC block showed significantly better control as compared to the patients without PEC block group in females undergoing modified radical mastectomy under general anaesthesia.

BIOFILLER VS PLATELET RICH PLASMA MESOTHERAPY IN THE TREATMENT OF PERI-ORBITAL HYPERPIGMENTATION IN PATIENTS PRESENTING TO OUTPATIENT DEPARTMENT OF DERMATOLOGY IN A TERTIARY CARE HOSPITAL-AN RCT

Mon, 05 Feb 2024 00:00:00 +0000

Background: Peri orbital hyperpigmentation (POH) is a common presentation in dermatological outpatient departments and has multiple causes. Finding an appropriate treatment for POH can be challenging and requires case-based approach. The objective of this research was to study the effect of Biofiller Vs Platelet rich plasma meso-therapy in the treatment of Peri-orbital hyperpigmentation. Our hypothesis was “Biofillers are better than platelet rich plasma therapy in the treatment of peri-orbital hyperpigmentation”. It was a double-blinded randomized Control Trial (IRCT20230816059168N1) carried out in the Dermatology OPD of a tertiary care hospital in Rawalpindi over 4 months, i.e., 10.07.23 to 10.10.23. Methods: Forty-two patients meeting the inclusion criteria were included in the study after taking informed consent. Sampling was done by non-probability randomized sampling using the lottery method. 21 patients were treated with Bio fillers and another 21 by platelet rich plasma therapy (PRP). Sessions with a 2 weeks interval were done in each case and results were analyzed by peri-orbital photo-metric pigmentation scale and clinical grading improvement scale rated by a physician. Patient satisfaction and complications were also recorded. Results: Statistically significant difference in results of Group A as compared to Group B, regarding improvement in photonumeric scale, evaluation of efficacy by a blinded dermatologist and patient satisfaction i.e. p= 0.001, 0.014 and 0.001 respectively. In group A, pain was reported by 3 (14.3%), bruising by 1 (4.76%) and lumps by 2(9.5%). PRP treated group had more side effects, i.e., 9 (42.8%) reported pain, 6 (28.6%) bruising and 4 (19%) more than one complaint (p-0.001). Conclusion: Biofillers are better than PRP in the treatment of POH.

COMPARISON OF THE ACCURACY OF ULTRASONOGRAPHY AND CONVENTIONAL RADIOGRAPHY IN DETECTING FRACTURES IN INDIVIDUALS WHO HAVE A CLINICAL SUSPICION

Sadia Naseer Qazi, Adil Qyyum, Nisar Ahmad, Ruqqia Adil — Mon, 05 Feb 2024 00:00:00 +0000

Background: Fracture detection plays a crucial role in clinical settings, influencing patient management and treatment decisions. Traditional methods, such as conventional radiography, have been the standard for fracture imaging. However, with advancements in technology, ultrasonography has emerged as a potential alternative, offering benefits such as portability and the absence of ionizing radiation. This study aims to compare the accuracy of ultrasonography and conventional radiography in identifying fractures in individuals presenting with clinical suspicion. The primary objective of this study is to assess and compare the diagnostic accuracy of ultrasonography and conventional radiography in detecting fractures. By evaluating both imaging modalities, we aim to provide insights into the potential utility of ultrasonography as a viable option for fracture diagnosis, particularly in cases where conventional radiography may present limitations. Methods: This prospective comparative study involves individuals with a clinical suspicion of fractures, who will undergo both ultrasonography and conventional radiography. The imaging results will be independently assessed by experienced radiologists blinded to the clinical information. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy will be calculated for both modalities. Statistical analyses, including paired t-tests, will be employed to determine significant differences between the two methods. Results: Preliminary results indicate that ultrasonography demonstrates comparable accuracy to conventional radiography in detecting fractures. Sensitivity, specificity, and overall accuracy will be presented, highlighting the strengths and limitations of each imaging modality. Any statistically significant differences between the two methods will be discussed in detail. Conclusion: This study contributes valuable insights into the comparative accuracy of ultrasonography and conventional radiography in fracture detection among individuals with clinical suspicion. The findings aim to guide healthcare professionals in making informed decisions regarding the choice of imaging modality based on the clinical context and available resources.

THE DICHOTOMY BETWEEN HEAT SHOCK PROTEIN-27 AND MICROALBUMIN: COVARIATE OF EARLY DIABETIC NEPHROPATHY

Mon, 05 Feb 2024 00:00:00 +0000

Background: Heat shock protein-27 is the microprotein released from renal parenchyma during diabetic oxidative stress, while microalbumin is the plasma protein that appears in urine in diabetic nephropathy. Methods: This case-control study was conducted from Jan to Sep 2021 in the Physiology department, BMC, BMCH, Quetta. The current study included 105 patients with an age range from 30–50 years and was divided into three groups: i) a control group of healthy participants, ii) a diabetic risk group: participants without signs of diabetic nephropathy and diabetic duration from 1–5 years, iii) diabetic nephropathy group: participants having >30 mg/dl of v microalbumin in urine and diabetic duration from 5–10 years. Results: There were significant mean differences between all groups with respect to anthropometric measurements except in height amongst all groups. Statistically significant mean differences were seen in the risk and nephropathy group with respect to serum FBG, RBG, and HbA1_c. Elevated microalbumin levels in the diabetic nephropathy group (50.9±8.2) compared with the diabetic risk group (15.4±2.9). Similarly, higher levels of HSP-27 were seen in the diabetic nephropathy group (230.46±23.75) as compared with the diabetic risk group (117.60±14.50). Conclusion: HSP-27 is a better biomarker than microalbumin and may show early glomerular injury in the early diabetic stage of diabetic nephropathy

EFFICACY AND SAFETY OF PNEUMATIC LITHOTRIPSY WITH LASER LITHOTRIPSY IN THE TREATMENT OF URETERAL STONES <20 MILLIMETERS IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Wed, 17 Apr 2024 00:00:00 +0000

Background: Ureterorenoscopy (URS) in treating ureteral stones in children is preferred for >10 mm-sized stones. Pneumatic lithotripsy is often used, but laser lithotripsy is gaining more popularity over the years, as it is considered better in terms of safety and efficacy. However, no previous meta-analysis has discussed the comparison of these two modalities. This meta-analysis compared pneumatic and laser lithotripsy in children with ureteral stones. Methods: This meta-analytic study followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Inclusion studies were retrieved by thoroughly searching Pubmed, Scopus, ScienceDirect, Web of Science, and Embase databases, focusing on the comparative intervention of pneumatic and laser lithotripsy in the paediatric population. Result: Study analysis showed that laser lithotripsy had a significantly higher stone-free rate (OR: 2.06; 95% CI: 1.06 – 4.00; p=0.03) and lower stone retropulsion (OR: 0.37; 95% CI: 0.16–0.87; p=0.02) compared to pneumatic lithotripsy. However, mean operative time (MD: 2.33; 95% CI: -4.09–8.74; p=0.48), length of stay (MD: -0.17; 95% CI: -0.36–0.02; p=0.08), post-operative fever (OR: 1.50; 95% CI: 0.48–4.66; p=0.48), and ureteral injury (OR: 0.43; 95% CI: 0.08–2.48; p=0.35) was not different between the two groups. Conclusion: A higher stone-free rate (SFR) and a lower incidence of stone retropulsion can be achieved using laser lithotripsy instead of pneumatic lithotripsy for treating ureteral stones in children.

SUPERIOR MESENTERIC ARTERY SYNDROME COUPLED WITH RENAL NUTCRACKER SYNDROME

Wed, 17 Apr 2024 00:00:00 +0000

An acute vascular angle between the superior mesenteric artery and the Aorta may compress the third part of the duodenum (SMA Syndrome) and the Left Renal Vein (Renal Nutcracker Syndrome). Usually, patients are young females with a lean stature. Symptoms of outlet obstruction and pelvic congestion syndrome may be present. Our patient presented with bilious vomiting and unintentional weight loss for the last 6–8 months. On further inquiry, she had dysmenorrhea and left flank pain associated with microscopic haematuria. Duodenojejunostomy with Left Renal Vein (LRV) re-positioning was performed. She recovered uneventfully and has improved intake with mild or no pain troubling her at 6 weeks of surgery.

UNVEILING A RARE CASE OF KIKUCHI-FUJIMOTO IN SINDH, PAKISTAN

Wed, 17 Apr 2024 00:00:00 +0000

Kikuchi-Fujimoto disease (KFD) commonly manifests with symptoms of fever, tender cervical adenopathy, and systemic symptoms like night sweats, rashes, headache, weight loss, nausea, vomiting, and sore throat. In this case study, a 27-year-old patient's main complaints included fever, neck oedema, and weight loss that started one month ago. Following preliminary inquiries, ultrasonography, and CT scans, a multidisciplinary team has been overseeing the case. After a biopsy of axillary and cervical lymph nodes, it has been diagnosed as a case of Kikuchi-Fujimoto disease overlapping with Systemic Lupus Erythematous. Symptomatic and specific treatment started which showed improvement in 4 weeks. The treatment is symptomatic because of the benign characteristic and typical resolution within several weeks to months. The prognosis is usually excellent without an increased risk of malignancy or mortality.

PAEDIATRIC CASE OF 3-METHYLCROTONYLGLYCINURIA WITH ENCEPHALOPATHY: A CASE REPORT FROM PAKISTAN

Murtaza Ali Gova, Noshaba Noor, Hira Nawaz, Rameen Akhter Molani — Wed, 17 Apr 2024 00:00:00 +0000

3-Methylcrotonylglycinuria is a common inborn error of metabolism (IEM) resulting from the deficiency of 3-Methylcrotonyl-CoA carboxylase (3-MCC) and its prevalence ranges from 1:2400 to 1:6800. The disease may be asymptomatic or may present with signs of "metabolic crisis". In our four and a half months old male patient, the disease manifested as fever, fits and an altered level of consciousness, along with signs and symptoms of metabolic crisis. The purpose of this case report is to highlight a clinical presentation of 3-MCG, as seen in this patient to ensure timely diagnosis and treatment.

SCLEREDEMA DIABETICORUM; A RARE DISEASE

Wed, 17 Apr 2024 00:00:00 +0000

Scleredema Diabeticorum (SD) is a rare condition characterized by diffuse, symmetrical induration along with non-pitted swelling mostly on the upper back as a result of mucin being deposited in the dermis. It can also involve posterior neck, shoulders, and scalp. We report a case of 48 years old female patient from Pakistan, with uncontrolled diabetes mellites type 2 for the last 15 years, presenting with thickened skin at the back of the neck resulting in difficulty in neck and shoulder movements. This led to decreased functional class from I to II causing her to develop insomnia and depression. Scleredema diabeticorum is a difficult disease to manage as it runs a long and debilitating course with little propensity of remission with available treatments.

LEMIERRE SYNDROME: A FORGOTTEN INFECTION

Raza Ullah, Shahada Naz, Haleema — Wed, 17 Apr 2024 00:00:00 +0000

Lemierre’s syndrome is a serious disease caused by an anaerobic bacteria called Fusobacterium necrophorum, which usually occurs in healthy teenagers and adolescents. The infection takes place in the throat and spreads through septic thrombosis of the tonsillar and internal jugular veins. The resulting bacterial infection is complicated by septic emboli in several places such as the lungs, joints and bones. Fever, pharyngitis, dysphagia, odynophagia, or swelling of the oropharyngeal is a common symptom. Although rare, there has been evidence of a recurrence of the condition in recent years, which may be associated with a reduction in the use of antibiotic therapy for the cold throat. The typical clinical image is characteristic, but many doctors do not recognize the condition and diagnoses are often delayed with potentially fatal consequences. We are presenting a similar case of Lemierre’s syndrome in an elderly female with pharyngitis, resulting in thrombophlebitis, empyema and discharging neck sinus.

EFFICACY AND SAFETY OF OLOKIZUMAB IN THE MANAGEMENT OF RHEUMATOID ARTHRITIS- A SYSTEMATIC REVIEW AND META-ANALYSIS

Mon, 05 Feb 2024 00:00:00 +0000

Background: Olokizumab (OKZ) is a monoclonal antibody against the interleukin receptor-6 that has shown promise in recent phase II and III trials in patients of rheumatoid arthritis (RA). This meta-analysis aims to evaluate the efficacy and safety of Olokizumab in managing rheumatoid arthritis. Methods: We searched different databases until March 2023 for randomized controlled trials inspecting the effects of OKZ on various outcomes in RA patients inadequately controlled with anti-TNF or methotrexate. Data were analyzed via Review Manager-v 5.4.1. Relative risks (RR) with 95% confidence intervals were calculated. Results: We evaluated five trials with 2761 patients under four treatment groups: 60mg OKZ administered 2-weekly, 64mg 2-weekly, 64mg 4-weekly, and 120mg 2-weekly. Clinical response as measured by ACR 20, 50, and 70 showed statistically significant improvement with the use of OKZ. A 50% disease improvement was seen across all 4 treatment groups (OKZ 64 mg q2w: RR= 2.96, p<0.0001, OKZ 64mg q4w: RR= 3.06, p=0.0002, OKZ 60 mg q2w: RR=5.06, p=0.007, and OKZ 120mg q2w: RR= 3.63, p=0.04). Moreover, 20% and 70% improvements were also noted with OKZ in doses 64mg 2-weekly and 4-weekly. Disease remission, as indicated by DAS28 <2.6 was also significantly higher than placebo across all groups. Safety data showed comparable mortality rates in treatment and placebo groups (OKZ 64mg q2w: p=0.48, OKZ 64 mg q4w: p=0.93). Conclusion: In conclusion, Olokizumab has shown significant improvement in disease activity compared to placebo with a favourable safety profile. However, further larger and longer-term studies are required to confirm these findings.

REVISITING THE MBBS CURRICULUM: STRENGTHENING PUBLIC HEALTH EDUCATION IN PAKISTAN

Muhammad Ahmed Abdullah, Babar Tasneem Shaikh — Mon, 05 Feb 2024 00:00:00 +0000

Pakistan faces significant public health challenges, including high rates of stillbirths, infant and under 5 child mortality, women dying during childbirth, low contraceptive prevalence rate, the upsurge of infectious diseases, and a significant burden of non-communicable diseases. Are we preparing skilled enough public health workforce? The healthcare system is fragmented and unregulated, lacking uniform care and a severe shortage of skilled human resources. Health system strengthening has one of six building blocks on the health workforce which is crucial for any public health intervention. The existing undergraduate MBBS curriculum in Pakistan uses "community medicine" interchangeably with "public health," despite the broader scope of the latter. Community medicine constitutes 8% of the teaching time, covering topics such as basic health concepts, health promotion, entomology, and reproductive health. To address emerging global health challenges, the MBBS curriculum should be updated. It should include scientific domains like epidemiology, health economics, medical statistics, sociology, psychology, and health management sciences. Research skills, evidence generation, and the use of information for decision-making should be emphasized. New methods of student assessment, program evaluation, and practical experiences are vital. Collaboration among public health practitioners, academicians, and medical educationists is needed to develop a holistic and technically sound curriculum. Pakistan requires an updated MBBS curriculum to meet the public health challenges of this century. It should incorporate interdisciplinary subjects, and innovative assessment methods, and prepare medical graduates for dealing with the public health emergencies of our times.

TECHNOLOGY, COLLABORATION, AND HUMANISTIC VALUES: A TRIAD FOR REVOLUTIONIZING MEDICAL EDUCATION

Muhammad Junaid Khan — Sat, 30 Mar 2024 00:00:00 +0000

Medical education must be revolutionized in today's rapidly evolving healthcare industry. Embracing technology and encouraging collaboration among educators, students, and healthcare facilities is critical for preparing students for best practices. Virtual reality, simulations, and online learning platforms enhance medical education, whereas interprofessional education encourages collaboration and mutual respect among healthcare professionals. Collaboration reduces inequities in medical education while ensuring high-quality learning experiences for all students. However, humanistic ideals must be prioritized, with instructors promoting compassion, understanding, and patient-centered care in learners. By embracing technology, collaboration, and humanistic values, we can better prepare future generations of healthcare providers to navigate modern medicine and offer high-quality care to patients globally.

HYDROCEPHALUS AND CRANIOSYNOSTOSIS IN PAEDIATRICS: COEXISTENCE OF TWO PHENOMENA

Khrisna Rangga Permana, Muhammad Arifin Parenrengi, Wihasto Suryaningtyas — Sun, 24 Mar 2024 00:00:00 +0000

Background: Here, the authors describe their institutional experience managing patients who had hydrocephalus and craniosynostosis regarding their pre-operative and post-operative data. Methods: The study was conducted in the Neurosurgery Department, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia. Four patients with craniosynostosis had hydrocephalus based on our database and all of those four cases were reviewed. The authors retrospectively reviewed the patient's demography, clinical findings, radiology results, operative procedures, and complications after surgery. Results: Four patients underwent the cerebrospinal fluid (CSF) procedure and survived the procedure. Three patients were operated at the first 1 year of age and one patient at 2 years old. There were no major complications (sepsis, reoperation, death) postoperatively. Conclusion: The mechanism of the hydrocephalus in craniosynostosis was not fully elucidated. Suspicion of hydrocephalus should be anticipated in every case of craniosynostosis and further examination such as a CT scan was necessary. In the setting of progressive ventriculomegaly, a CSF diversion should be performed.